Inspection on 04/06/08 for Kelstone Court Nursing Home

This inspection was carried out on 4th June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kelstone Court Nursing Home 05/12/07

Kelstone Court Nursing Home 27/03/07

Kelstone Court Nursing Home 13/11/06

Kelstone Court Nursing Home 08/12/05

Kelstone Court Nursing Home 30/06/05

Kelstone Court Nursing Home 06/01/05

Kelstone Court Nursing Home 28/07/04

Similar services:

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Henry Nihill House

Birchwood

The Infirmary

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Kelstone Court Nursing Home Cambourne Road Morden Surrey SM4 4JN Lead Inspector Jean Stuart Key Unannounced Inspection 4th June 2008 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kelstone Court Nursing Home Address Cambourne Road Morden Surrey SM4 4JN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8542 0748 Yourcare Ltd Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 30 5th December 2007 Date of last inspection Brief Description of the Service: Kelstone Court is a registered care home with nursing providing accommodation and care for up to thirty residents. Twenty places are for older people who require nursing care. Ten places are for older people who require residential care. Accommodation is set over three floors with a passenger lift available for access. The home is a large purpose built property situated in a residential area of Morden in Surrey. The home is close to a group of local shops and a pub with Morden Park and Cannon Hill recreation grounds nearby. Public transport is easily accessed from the home and unrestricted parking is available in the local area. The home is owned by Yourcare Limited. Fees for this service are from £578 to £625 per week. Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means people who use this service experience good quality outcomes. An inspector and an expert by experience undertook this unannounced inspection. We spent eight and quarter hours at the home from 9.45 am to 6pm, and spoke with 23 people about their experiences at the home. Time was also spent with six members of staff, a visiting GP, and a relative. Records and documents including care plans, risk assessments, medication, food records and the complaint log were examined. A tour of the premises and the lunch time meal was observed. The home completed an Annual Quality Assessment (AQAA), information from this has been included in this report. What the service does well: What has improved since the last inspection? Requirements set on the last inspection have now been achievedThe home is moving towards more individualised care. Details of people’s social, cultural and religious needs are recorded. For each individual a life history has been collected. At lunchtime carers were seen sitting with people to help them with their food. Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 6 Carers were seen spending time talking to people. The dining room was in use, and condiments provided for people. The cultural dietary needs of people are catered for. A shelter has been provided outside for people who smoke. Records are maintained of staff training. Longstanding maintenance issues are being addressed, and the kitchen has been refurbished. There is a programme of ongoing improvement throughout the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6. People who use the service experience good quality in these outcome areas. This judgement has been made using available evidence including a visit to this service. People can be confident that they will have sufficient information before they stay at Kelstone Court. Information could be more useful in a user friendly format. People’s needs are assessed prior to admission and a plan of care drawn up to meet these needs. EVIDENCE: People spoken with confirmed that they had information before moving in. For some people a service user guide in a user friendly format could help the to understand the services the home offers. Illustrations could be used to supplement the written text. Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 9 No one is admitted unless an assessment has been carried out, this includes questions about gender, disability, race, age, and religion. This ensures that the service can provide the required level of support to people. Staff have information on the needs and wishes of individuals before they arrive at the home. Pre-admission assessments are used to set up a care plan detailing assistance people require. If they is a vacancy the home will offer intermediate care with the initial assessment of need provided by Social Services. Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. People who use the service experience good quality in these outcome areas. This judgement has been made using available evidence including a visit to this service. People are usually involved in the care planning process. Action is being taken to make sure that care plans address individual needs. Information collected is less task based and more person centred. The plan could be improved by noting people’s strengths as well as their weaknesses. Risk assessments are completed and focus on keeping people safe. Arrangements for the administration of medication are satisfactory. EVIDENCE: Four peoples care plans were examined. Peoples’ plans are lead from their assessments and contained good details of how to deliver care. The plan of care involves the person or someone close to them. Part of individualised care is reflected in ensuring people dress in their preferred style. This is noted on Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 11 care plans and people were seen wearing the preferred clothing. Staff respect people’s dignity by knocking on bathroom doors, and ensuring for women wearing skirts, their laps are covered when using wheelchairs. Person centred planning is about meeting individual need. In many ways the home is doing this but it is initially difficult to see. Documentation is in several different forms and places. The main focus is on the nursing information. Once these documents have been read and people spoken with we saw more clearly the individualised nature of the service given. It is advised that the home considers how information is collected and how this can be brought together under a person centred plan. We discussed how care plans could be improved by looking at the positive aspects of a person’s lives and what they can do. The provider suggested that each aspect of the care plan could contain a statement about what can be achieved by the individual. This suggestion is in line with good practice. To promote people people use independence and mobility, walking aids. Risk assessments are maintained to ensure that areas are kept clear of furniture and a record is maintained of falls and how to prevent these. Some people in the home smoke cigarettes and an outside shelter has been built to provide a degree of comfort when outside. All people are registered with local GP practices, however the majority of people see one GP. The GP reported very favourably on the work the home puts into caring for people. The home’s staff addresses people’s health care needs. The Local GP was a complimentary of their good practice. The chiropodist and optician also visit regularly. We found medication sheets, and the records of controlled drugs were up to date and accurate. Medication profiles are in place Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People who use the service experience good quality in these outcome areas. This judgement has been made using available evidence including a visit to this service. People are able to pursue interests of their choosing. Spiritual needs are acknowledge and supported. Family and friends visit the home. Meals are well balanced, and special diets are catered for. A record of all food served is maintained. EVIDENCE: People are able to enjoy activities both in the home and in the community. The home has considered their varied interests when planning the routines of daily living and arranging activities. The expert by experience found the activity person to be highly praised by people. Activities reflect the diverse needs of the group, considering age, disability, and religion. People spoke of their enjoyment of the quizzes and bingo, “going to a party with family, a taxi has been booked” another person enjoyed the trip to a local garden centre. Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 13 Clergy from both the Catholic and Church of England faiths visit. People are given quiet undisturbed time for prayer if they wish. A relative who visits the home several times in week spoke very highly of the care given. The nature of any activity should be established on admission. A person centred plan should focus on the individual and their strengths and personal preferences. For example do people use the table to eat, how are clothes protected when eating, how often do people bathe/shower. How are they comforted if upset. For people whose first language is a not English illustration may help them understand the choices that are available. Such issues are important to personal centred planning and should be documented so that knowledge is shared between people. People spoken with enjoyed the food offered. Typical comments were the “food is good” “we have choices” “I enjoy the food”. The expert by experience observed carers sitting with people and exchanging conversation with them. People with dietary needs based on their culture are catered for. We saw that a range of different food was served on the day, and that a vegetarian diet was provided. This was recorded on the record of food served. At lunch time six people chose to use the dining room. Trays were placed on the table in front of people. This is an institutional practice. The dining room is a pleasant area with linen table clothes and napkins. When asked why the dining room was not used, people said it was cold, an outside door had been left open. A person who wished join a in the dining room was assisted by staff to achieve this. Pleasant music was played at dinnertime. The lounge has five televisions. As seen by the expert by experience people hold the remote controls of some TVs, the volume of the TVs were turned down but remained on during lunch. Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People who use the service experience good quality in these outcome areas. This judgement has been made using available evidence including a visit to this service. People feel safe and secure in the service provided and are aware of how to use the complaint procedure. If people have concerns about their care this is looked into and action taken. People are protected from harm by appropriate training for staff. EVIDENCE: Comments from people were that they have “no complaints” on survey forms from relatives it was stated “I never need to make a complaint” “there is nothing to complain about”. Individuals felt able to speak with the nursing staff about any issues they may have. The complaint log reflected two complaints by people who were unhappy when they had to sit elsewhere. This situation has been rectified indicating that people are listened to and peoples concerns acted upon. The home’s AQAA indicated that they had received four complaints and concerns since the last inspection. All matters were recorded in the complaint log. Staff informed us that complaints are as far as possible dealt with straight Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 15 away and this was reflected in the complaint log. A care manger reported that they had not received any complaints. Staff reported that they had received training in Safeguarding Adults, there are policies and procedures to access if necessary. This was confirmed in the AQAA. Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. People who use the service experience adequate quality in these outcome areas This judgement has been made using available evidence including a visit to this service. The environment is clean, safe and comfortable. The accommodation has many maintenance issues, which are now being dealt with. Certain parts of the building require attention to reach a good standard. EVIDENCE: People were positive about the environment provided. One person said they are “very comfortable”. As indicated by the AQAA the home has a pleasant garden which one person was sitting in. For people who smoke a substantial shelter has been erected to ensure that they have some protection from the weather. The garden is accessible by a ramp, which could help people with poor mobility. Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 17 The home was well lit, clean and tidy and smelt fresh. An expert by experience found their first impression of the home “was the smell, urine and it was strong”. Survey forms from ten relatives found no reason to complain about the home. We later sat in this area speaking with a relative and did not note any mal odours. Certain parts of the building require attention to reach a good standard. The paint work in bedrooms and bathrooms is tired in many areas, and damage is obvious to door frames. Bedrooms viewed were tidy. People had their own photos, personal items, and pictures on the wall. Overall the home provides a pleasant environment. As reported in the AQAA many areas have new carpet, with new chairs in the lounge. The Kitchen has been refurbished and it was reported the laundry fittings are two years old. The lounge has many televisions and it was noted that some people have the control of the remote allowing them to select their own programmes. Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People who use the service experience good quality in these outcome areas. This judgement has been made using available evidence including a visit to this service. People are supported by sufficient numbers of staff that respond appropriately to their needs. There is a comprehensive recruitment procedure, which must be followed in full to protect people from harm. Staff have benefited from NVQ level two training. Staff are appropriately trained to support people. EVIDENCE: Feedback about the way staff carry out their duties was positive. Comments included “nice nurses” “staff work so hard”. The expert by experience was informed, “Staff can not do enough for me, they are very kind. Sufficient staff were on duty to meet the needs of people. We found staff to have a good understanding of the needs and preferences of people, they interacted with people and many showed good communication skills. Staff spoken to had completed NVQ level two and three. Courses in the Protection of Vulnerable Adults (POVA), moving and handling, giving personal Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 19 care, incontinence, fire health and safety have been completed. The individual staff files supported these statements. The deputy manager demonstrated that the service has an understanding of equality and diversity throughout their recruitment process employing staff of different genders and from different cultures. Staff reported that their references were collected and CRB check carried out before they were employed. The staff files supported this. However the staff file for a new recruit showed that gaps in their work history had not been explored. To safe- guard people a full record of a persons working history should be collected Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. People who use the service experience good quality in these outcome areas. This judgement has been made using available evidence including a visit to this service. The home is currently with out a manager. The deputy manager has taken on the duty of manager and has been very conscientious in fulfilling this role. People. The information in the AQAA was not fully supported by appropriate evidence. People’s finances are managed appropriately and securely The view of people, families and other stakeholders are sought on a regular basis. Kelstone Court follows safe working practices. EVIDENCE: Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 21 The home has completed an AQAA that contains information of how the home is run. The information given in the AQAA, should relates to the section covering particular National Minimum Standards and be clear and relevant. The AQAA lets us know about changes a service has made and where they intend to make improvements. The data section of the AQAA was accurately and fully completed. The provider said a manager has been appointed and it is anticipated that he will start in the next week. An application for registration must be made to the CSCI as soon as possible. The home is safe for people and staff because health and safety procedures are carried out. Many records are maintained concerning safety issues around the environment. The record of fire checks was seen. Policies and procedures are up to date. The view of families and stakeholders are sought. A family member confirmed that her views are sought in the relatives meetings. People’s finances were checked. Receipts for all purchase are available. We found that the record and the amount of money available matched. A satisfactory record is maintained. Staff spoken to felt well supported by the deputy manager and the providers. They said, “Kelstone Court is a very good place to work and the owners are always very understanding and supportive”. The record of supervision showed that the frequency of supervision had fallen during the absence of the manager. The provider reported that the new manager will start soon and supervision for all staff will recommence. As stated in the AQAA “more thought” is to be given to the annual development plan to identify what is achievable. A development plan would demonstrated what the home wishes to achieve in the best interest of people. Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP31 Regulation 8 Requirement The provider must ensure that a suitable person is appointed to run the home and the CSCI registration process commenced. Timescale for action 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP1 OP7 OP19 OP29 OP33 Good Practice Recommendations Consideration should be given to providing the service user guide in a more easily accessible format. To ensure that service users can appreciate what the home offers. Care provided should reflect what people can do independently. This will help people to maintain their individualised life style. The home should be maintained to a good standard, promoting the persons sense of well being. To protect people from harm a full employment history should be gathered from all prospective employees A development plan should be produced demonstrating what the home wishes to achieve in the best interest of people the views of people who use the service. DS0000060496.V365053.R01.S.doc Version 5.2 Page 24 Kelstone Court Nursing Home 6. OP33 The information in the AQAA should be fully supported by appropriate evidence. Kelstone Court Nursing Home DS0000060496.V365053.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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